6.8. Types of Care
The SCI/D Support Clinic or SCI/D Primary Care Team (PCT) provides comprehensive primary care to Veterans with SCI/D, ensuring access to basic and preventive health care services, and delivers appropriate, efficient, continuous and coordinated care between the patient and the health care team.
- Basic Primary Care. Basic primary care is provided by the SCI/D Support Clinic or SCI/D PCT.
- Recurrent or Persistent Problems. Recurrent or persistent problems (e.g., recurrent urinary tract infections, autonomic dysreflexia that does not resolve with appropriate interventions) need to be referred to the SCI Center or discussed with SCI Center staff.
- Complex Problems and Procedures. Complex problems and procedures that require specialized knowledge must be referred to the SCI Center (e.g., comprehensive pain management, respiratory infections in Veterans with high tetraplegia, urodynamics). While comprehensive and coordinated health care is the goal of the SCI/D Support Clinic or SCI/D PCT, SCI/D Center experts are best able to diagnose and treat complex SCI/D-related conditions. NOTE: The SCI/D Support Clinic and SCI/D PCT working collaboratively with their SCI Center helps to ensure healthier Veterans with SCI/D. There is no "one-size-fits-all" model that fits the collaboration between SCI/D Support Clinic and SCI/D PCTs and SCI Centers because the expertise and experience in SCI/D Support Clinics and SCI/D PCTs with SCI/D-specific conditions vary. The general principles and illustrative examples in this handbook are helpful in developing optimal models of collaborative care between SCI/D Support Clinic or SCI/D PCTs and SCI Centers. A more comprehensive list of specific conditions is included in subpar. 27.a.
- Major Surgeries. Major surgeries must always be performed in the SCI Center unless an emergency contraindicates transportation of the patient. Some examples of surgeries that must be performed in the SCI Center include myocutaneous flaps for pressure ulcers, genitourinary surgeries, colostomies, orthopedic procedures (e.g., carpal tunnel release, rotator cuff repair), spine surgeries, and neurosurgical procedures.
- Acute Rehabilitation and Complex Specialty Care. All acute rehabilitation and complex specialty care must take place at SCI Centers. Primary care services, or short-duration hospitalization, at non-SCI Centers may decrease the necessity of patient transfers to the SCI Center.